OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Data and Technical Assistance (DATA) Task Order to Support the Infant Mortality CoIIN

IC 230710 under ICR 201502-0915-002 · OMB 0915-0212.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Data and Technical Assistance (DATA) Task Order to Support the Infant Mortality CoIIN
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 DATA CoIIN_ Post-TA Webinar Evaluation Survey.pdf DATA CoIIN_TA Webinar Evaluation Survey.pdf Yes Yes Fillable Fileable
Form 2 DATA CoIIN_Post-Stakeholder Webinar Evaluation Survey.pdf DATA CoIIN_Stakeholder Webinar Evaluation Survey.pdf Yes Yes Fillable Fileable
Form 3 DATA CoIIN_Web-based Shared workspace/Online Platform Survey.pdf DATA CoIIN_Online Platform Survey.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

540 53
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,670 0 2,670 0 0 0
Annual IC Time Burden (Hours) 214 0 214 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic DATA COIIN Supporting Statement GENERIC - Supporting Statement_DATA CoIIN_030918.docx 03/14/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.